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Nearly 3 years after my Gleason 6 diagnosis and radical prostatectomy, my PSA started to rise again. My urologist (not a cancer specialist) pronounced that “it must have gone metastatic”. (Did he really know, or was this merely a hunch?) I have been on intermittent ADT (one nominally 3-month insert every six months) for over 9 years. My PSA remains too low to record, and I am unaware of any particular side effects. I am delighted with this outcome, but I keep wondering about this “metastatic” label. On the other hand, if it is not metastatic, then what is it, and where is it? It raises the basic question: is a urologist really qualified to declare a prostate cancer as being metastatic?